Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 994310 DEA: 034F6504 EFIS: 0314000233
QA Service Level: 1
DIST-CO-RTE-PM: 03-YOL-50,80-0.0/2.5,4.1/R11.4
Work Description: CRCP, HMA (TYPE A), RDWY EXC, CLASS 2 AB, FIBER OPTIC CABLE SYSTEMS.
Location Description: YOLO COUNTY IN AND NEAR WEST SACRAMENTO ON ROUTE 80 FROM 1.7 MILES EAST OF MACE BOULEVARD OVERCROSSING TO SACRAMENTO RIVER BRIDGE AND OVERHEAD (BRYTE BEND) AND ON ROUTE 50 FROM ROUTE 80 JUNCTION TO JEFFERSON BOULEVARD UNDERCROSSING
Contractor Name: Flat-Iron Teichert A Joint Venture
Contractor Address: 1200 Concord Avenue Suite 465, Concord, CA 94520
Resident Engineer: Daniel Tecle Structure Rep.: Brent Bullard
DIME Sample ID: 2023-12-14-5
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - FFS - Skid Testing
Sample Organization Contact: (916) 227-7287
Type of Sample: Department Acceptance
Type of Material: Roadway/Bridge Surface
Sample Taken Date: 12/14/2023
Date that the sample was received by the laboratory/organization performing the testing: 12/14/2023
The quantity of what the sample constitutes: TRIAL SLAB
A brief description of the sample: TRIAL SLAB
From where was the sample collected: Job Site
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JOB SITE
DIME Test ID: 2023-12-14-5-1
Test Method: CTM 342-August 2012: Method of Test for Surface Skid Resistance with the California Portable Skid Tester (Skid)
Verified Date: 12/15/2023
Date Tested: 12/15/2023
Submitted By Organization: CT HQ - FFS - Skid Testing
Organization Address: ,
Organization City:
Organization State:
Organization Zipcode:
Organization Email: steven.seifert@dot.ca.gov
Organization Phone: (916) 227-8588
General Comments for this Test: TEST PANEL/POLY
Test Result Compliance: complies
Additional Comments When Verified:
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Pavement or Bridge Deck?
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Bridge Deck
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Average Coefficient of Friction
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0.40
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